Iranian Journal of Orthopedic Surgery

Abstract  Background: Some authors suggested using ultrasound in diagnosis of carpal tunnel syndrome (CTS), however the efficacy of ultrasound in determining the severity of disease is unclear. In current study, we aimed to investigate the diagnostic efficacy of ultrasound in determining the severity of CTS in comparison with NCV using measurement of cross-sectional area of median nerve. Methods: In a prospective study, 181 CTS suspected wrists (94 patients) were investigated. The cross-sectional area of the median nerve was measured using ultrasound and the severity of disease was determined based on criteria of El Miedany et al. Based on the NCV, the patients were divided into four groups of normal, mild, moderate or severe CTS. Finally, the mean cross-sectional area was compared between the groups and the kappa agreement coefficient for determining the severity of disease by the two methods was calculated. Results: The mean cross-sectional area increased significantly with increase in disease severity (p < /i>>.001). Conclusions: Determination of cross-sectional area of median nerve with ultrasound can be a useful tool in decision-making about surgical intervention in carpal tunnel syndrome. However, the clinical correlation is mandatory.  

Abstract Background: Arthroscopic reconstruction of the anterior cruciate ligament is one the most common orthopaedic surgeries. There are scattered reports about the beneficial effects of post operative cox2-inhibitors administration on knee motion. The purpose of the current study was to determine the effects of cox-2 inhibitor on pain, range of motion and weight bearing after arthroscopic reconstruction of the anterior cruciate ligament. Methods: In this clinical trial, 70 patients who underwent arthroscopic reconstruction of the anterior cruciate ligament were assessed in a teaching hospital in Tehran-Iran. They were divided into case (cox2-inhibitor) and control groups. Postoperatively, pain, inflammation, range of motion and ability for full weight bearing were measured. Results: The mean of pain at the postoperative day 3 was 5.3±1.04 (visual analogs scale of 0 to 10) in the control and 3.3±0.71 in the case group. 29.6% of the patients in the control group and 82.8% in the case group were able to flex the knee more than 90° one week postoperatively. In the first week, all of the patients in the case group and only 28.6% in the control group were able to walk without any assistive device. The post operative knee circumstances were 2.73±0.59 and l.61±0.92 centimeters smaller respectively in case and control groups. Statistical analysis showed significant differences between the two groups, in the above measurements. Conclusion: Cox-2 inhibitor is effective in relieving pain reducing the inflammation, and accelerating the rehabilitation program after arthroscopic reconstruction of the anterior cruciate ligament.

Abstract Background: Incorrect tunneling is one of the concerns in arthroscopic anterior cruciate ligament reconstruction. The purpose of the current study was to determine the incidence of the correct femoral and tibial tunnel positions.Materials: In a cross-sectional study, the CT image positions of the tibial and femoral tunnels in 40 patients that had undergone arthroscopic ACL reconstruction using single-bundle hamstring tendon were studied. The parameters that were evaluated were: tibial tunnel position in axial and sagittal cuts, femoral tunnel position in axial cut, appropriate thickness of the posterior cortex at the intercondylar notch, and femoral exit point.Results: The correct position of the tibial and femoral tunnels, appropriate thickness of the posterior cortex at the intercondylar notch, and the correct position of the "femoral exit point" were respectively recognized in 60%, 52.5%, 70%, and 67.5%. In total, the correct position of the femoral and tibial tunnels was seen on 37.5% of patients. These parameters were compared with known standard anatomic positions.Conclusion: Although the incidence of correct tibial and femoral tunnel positioning in ACL reconstruction, when viewed separately, was acceptable when looked at as one tunnel was not satisfactory. More precise attention and expertise seem necessary for the operating orthopaedic surgeons.

Abstract Background: Prior to 1980 decade, surgical ideas and facts were mainly based on the individual surgeon’s experience and the collective judgment of groups of surgeons. In the 1980’s the concept of “Evidence Based Medicine” became popular suggesting that all surgical practices must be based on evidence and not experience. According to the widespread publication of medical articles nowadays, the question often arises about the dependability and strength of the evidence.  We are reporting the level of evidence (LOE) of articles published in the Journal of the Iranian Orthopaedic Association between 1995 and 2008. Methods: All the articles published in the Iranian Journal of Orthopaedic Surgery (1995-2008) were studied separately by 5 groups of physicians. The level of evidence rating system was based on the Journal of Bone and Joint Surgery, which classifies articles into therapeutic, prognostic, diagnostic and economic subgroups. The articles are subsequently divided into five levels in accordance with the defined levels of evidence.Results: Over half of the articles (54%) were therapeutic, 9% diagnostic, 35% prognostic and 2% economic. Overall 2% were placed as level I, 8% level II, 5% level III, 84% level IV and 1% level V.Conclusion: Therapeutic and prognostic articles and evidence level IV were the most common types observable in the articles published in the Iranian Journal of Orthopaedic Surgery. Furthermore, level I to III articles in this journal had increased over 3.5 times between 1995 and 2008.